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PATHOLOGY > TUMORS > Flashcards

TUMORS Flashcards

1
Q

____________stains ependymomas and choroid plexus

tumors, Decreased staining in higher grade tumors

A

GFAP

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2
Q

___________proliferation indices roughly

correlate with tumor grade and mitosis count

A

Ki-67 (MIB-1)

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3
Q

Molecular genetics of astrocytoma

__________in 40–50% of diffuse astrocytomas
(chromosome 17)—these appear to
progress more frequently
Increased ___________

A

TP53 mutations

platelet-derived growth factor
receptor (PDGFR)- mRNA expression

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4
Q

Cells with plump, eosinophilic cell bodies and
short processes
Nuclei are usually eccentric with small nucleoli
Perivascular lymphocytes common

A

Gemistocytic astrocytoma (WHO grade II)

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5
Q

Lots of gemistocytes associated with _________ behavior (20% or more gemistocytic
component)

A

more

aggressive

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6
Q

__________intensely eosinophilic, elongate,

or corkscrew-shaped structures

A

Rosenthal fibers—

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7
Q 
P16 deletion (30%), RB alterations (25%), P19
deletion (15%), CDK4 amplification (10%)

Hypercellularity with more prominent nuclear
pleomorphism vs low-grade astrocytoma
– Mitotic figures more readily identifiable

A

Anaplastic astrocytoma (WHO grade III)

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8
Q

Several possible origins
– Astrocytic dedifferentiation
– Nonastrocytic glioma differentiation

A

GBM

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9
Q

Several possible origins of GBM

  1. _________
  2. ________
A

– Astrocytic dedifferentiation

– Nonastrocytic glioma differentiation

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10
Q

Most common glioma, 50–60% of all astrocytic

neoplasms, 12–15% of all intracranial neoplasms

A

GBM

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11
Q

Pathology of GBM

  1. Perinecrotic __________ by tumor cells
    (may be variably present)
  2. Usually areas of prominent cellularity and
    nuclear pleomorphism
A

pseudopalisading

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12
Q

GBM are focally __ positive,________positive,

_______ positive

A

GFAP, S-100 , vimentin

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13
Q 
Considered by many to be a GBM variant, genetic
changes similar to GBM
 <2% of GBMs
 Similar presenting features, age distribution, and
prognosis as GBM
 Temporal lobe most common site
 Sarcoma and GBM microscopically
 Increased metastases—sarcoma part
A

Gliosarcoma/ Feigin’s tumor

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14
Q

– Generally looks like an infiltrating astrocytoma
– Peripheral margin cells are elongated and
slender
– Mitotic activity variable
– GFAP positive
– Secondary structures of Sherer common

A

Gliomatosis cerebri

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15
Q

Discrete cystic mass; radiographically a cystic
tumor with enhancing mural nodule(s)
Most common glioma in children, associated with
neurofibromatosis type I

A

Pilocytic astrocytoma (WHO grade I)

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16
Q

Associated with tuberous sclerosis (<20 years), can
occur later in life

Often associated with smaller hamartomas, which have been likened to “candle drippings

Giant cells with glassy eosinophilic cytoplasm
– Smaller elongated cells in background

A

SGCA

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17
Q

-First two decades, most commonly
-Seizures first decade of life
Cystic with mural nodule(s) configuration

A

Pleomorphic xanthoastrocytoma

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18
Q

Most arise in childhood, rarely adults
– Fasciculated and elongated cells
– May see anaplastic astrocytoma or GBM
– Most fibrillary, diffuse astrocytoma

A

BGG

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19
Q

First decade
Neurofibromatosis type I associated—bilateral
Adults—anterior optic pathway, aggressive

A

Optic Nerve Glioma

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20
Q

10–25% of glial neoplasms
Long history of signs and symptoms (mean 1–5
years) prior to diagnosis
Seizures, headaches most common symptoms;
about 20% hemorrhage

A

LG oliGo

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21
Q

-Sheets of cells, scant cytoplasm, rounded
central nucleus, vesicular chromatin
– Vacuolated “fried egg” appearance—formalin
fixation artifact
– Minimal nuclear pleomorphism
– Arcuate or “chicken wire” vascular pattern

A

ODG

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22
Q

Most frequent genetic alteration in ODG present is___

A

LOH

chromosome 19q

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23
Q

Type of ODG

Worse prognosis than low-grade tumor, median survival 3–4 years
1p and 19q chromosome deletions associated with increased likelihood of chemoresponsiveness

A

Anaplastic oligodendroglioma

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24
Q

– Flexner-Wintersteiner
• Small lumen
• Cuboidal lining

A

• Retinoblastoma

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25
Q

_______ (tumor cells arrange themselves

around something)

A

Pseudorosettes

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26
Q

– Homer Wright
• Fibrillary core
• Neuroblastic differentiation

A

PNET

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27
Q 
Any ventricle (especially 4th) and spinal cord
(intramedullary); most common tumor of the
spinal cord
A

Low-grade ependymoma

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28
Q 
– “Islands of blue (nuclei) in a sea of pink (fibrillary
background)”
– Nuclei-like ependymoma
– Mitoses rare, low cell proliferation marker
indices
– Calcification common
– GFAP and S-100 protein positive
– No rosettes or pseudorosettes
– Microcystic change common
– Excellent prognosis, surgical removal usually
curative
– More likely
A

subependyomoma

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29
Q

Slow growing
May be locally infiltrative, hemorrhagic, or
lobular
25% encapsulated
Filum terminale
Rarely subcutaneous sacrococcygeal region or
elsewhere in spinal cord

A

Myxopapillary ependymoma

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30
Q

May express progesterone > estrogen receptors

Most arise proximal to meninges from arachnoidal
cap cells;

______ is single most
common site of origin

A

MENINGIOMA

falx cerebri

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31
Q

__________—cells arranged in
lobules divided by collagenous septae, whorling of cells around vessels or psammoma bodies (calcifications), eosinophilic cytoplasmic
protrusions into the nuclei prominent
(nuclear pseudoinclusions)

______—spindle cells with
abundant collagen or reticulin between cells

– Transitional (mixed)—features of both
meningothelial and fibrous types

– Psammomatous—abundant _____

– Angiomatous—marked by prominent vasculature, not to be confused with hemangiopericytoma
or hemangioblastoma
– Microcystic—loose, mucinous background
– Secretory (pseudopsammomatous)—
formation of intracellular lumina containing
PAS positive, eosinophilic material
– ________ rich—marked by extensive chronic inflammation
– Metaplastic—demonstrates mesenchymal
differentiation

A

– Meningothelial (syncytial)

– Fibrous (fibroblastic)

calcifications

Lymphoplasmacyte

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32
Q

IHC of Meningioma

Most common cytogenetic abnormality is deletion of chromosome_____

A

Immunohistochemistry: most EMA and vimentin positive

22q

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33
Q

Four histological subtypes have been associated
with more aggressive behavior
______—areas similar to chordoma with
trabeculae of eosinophilic and vacuolated cells
in a myxoid background, WHO grade II tumor
_________—cells with clear, glycogen-rich
cytoplasm, WHO grade II tumor

_________perivascular pseudopapillary
pattern, WHO grade III tumor
_________rhabdoid-like cells with eccentric
nuclei, prominent nucleoli, and cytoplasmic
inclusions of intermediate filaments, WHO
grade III

A

– Chordoid

– Clear cell

–Papillary—

– Rhabdoid—

34
Q

Relatively rare sarcoma of CNS
May cause lytic destruction of adjacent bone, no hyperostosis
Grossly a solid, well-demarcated mass, tends to bleed during removal

A

Hemangiopericytoma

35
Q

Derived from notochordal tissue remnants
(ecchordosis physaliphora)
Most arise in spheno-occipital region or clivus
and sacrococcygeal region
Bone-based tumors, lobulated, may appear
grossly mucoid

A

Chordoma

36
Q

Positive for S-100 protein, HMB45, melan A;
negative for cytokeratin and GFAP stains

Poor prognosis

A

Melanoma

37
Q

Cerebellum most common site, less commonly brain stem and spinal cord

Cyst with enhancing mural nodule appearance
radiographically

A

Hemangioblastoma

38
Q

Associated with SV40 DNA sequences
Associated with Li-Fraumeni syndrome
Potentially curable by surgery with 5-year
survival rate of up to 100%

A

Choroid plexus tumors

39
Q

Homer Wright pseudorosettes < 40% of cases

Typical histopathology marked by densely packed
cells with high nuclear-to-cytoplasmic ratio

A

Medulloblas

40
Q

Histologically marked by rhabdoid cells
with eosinophilic cytoplasm, eccentric nucleus, prominent nucleolus

Cytoplasmic “pink body”—corresponds to
collections of intermediate filaments

express EMA and vimentin

A

Atypical teratoid/rhabdoid tumor

41
Q

Also known as neurilemmoma, neurinoma,
acoustic neuroma
Arises from peripheral nerve
8% of intracranial and 29% of primary spinal
cord tumors
Associated with neurofibromatosis type II

A

Schwannoma

42
Q

Cell types of Schwannoma

A

Composed microscopically of spindled cells
with alternating areas of compact cells (Antoni
A pattern) and less cellular looser regions
(Antoni B pattern)

43
Q

associated with

neurofibromatosis type II

A

Plexiform schwannoma—

44
Q

stains for schwannoma

A

strong and diffuse

staining with S-100 protein, GFAP negative

45
Q

Associated with neurofibromatosis type I
May present grossly as a cutaneous nodule or asa diffuse lesion;

plexiform tumors are multinodular
“bag of worms. Histologically composed of an admixture of Schwann cells, perineurial-like cells, and fibroblasts
in a mucoid/loose matrix

A

Neurofibroma

46
Q

MC supratentorial site of lymphoma

MC type

Virus associated in IC

A

Frontal

DLBCL

EBV

47
Q 
Grossly appear as yellow or white dural
nodules or granular parenchymal infiltrate
– Osteolytic bone changes
- Birbeck granules--tennis-racket-shaped
intracytoplasmic pentalaminar structures
A

Langerhans cell histiocytosis

48
Q

MC location of colloid cyst

A

Third ventricle—near foramen of Monro

49
Q

Subarachnoid space in the temporal lobe region
is favored site
Delicate, translucent wall filled with clear fluid
EMA positive by immunohistochemistry

A

Arachnoid cyst

50
Q

MC site of epidermoid cyst

A

Epidermoid: cerebellopontine angle is most
common site, may occur in other sites, i.e.,
suprasellar

51
Q

Locations of dermoid

A

Dermoid: posterior fossa, midline lesions, 4th

ventricle

52
Q

0.3–0.5% of primary intracranial tumors in adults, 3% in children
Occur along the midline,most commonly
suprasellar region and pineal

A

Germinoma

53
Q

Immunoreactivity:

________placental alkaline phosphatase, ________fetoprotein,
__________CD30,
___________—HCG and HPL

A

germinoma—

yolk sac–
embryonal carcinoma—
choriocarcinoma

54
Q

May originate from squamous cells at the base of the infundibular stalk

Cut section: necrotic debris, calcium, “cystic
oil” often with cholesterol
– Spillage of the “oil” may result in chemical
meningitis

A

Craniopharyngioma

55
Q

Most common secreting adenoma—_____

A

prolactinoma

56
Q

Microadenoma size

A

<1cm

57
Q

May be associated with developmental abnormalities,
i.e., agenesis of the corpus callosum

Usually midline: corpus callosum, 3rd ventricular
region, CP angle, quadrigeminal area

A

lipoma

58
Q

MC site of EDH

A

Most are frontal or temporal and associated with a laceration of one of the meningeal arteries,
most commonly the middle meningeal artery;
secondary to a fracture

59
Q

Resulting from tearing of bridging veins, which transverse through the subarachnoid space

A

SDH

60
Q

Microscopic dating of subdural hematoma
– A few days—intact red blood cells

\_\_\_\_\_\_\_lysis of clot with macrophages,
hemosiderin
– 2 weeks—growth of fibroblasts from the dural surface into the hematoma with small blood
vessel proliferation
\_\_\_\_\_\_early development of hyalinized
connective tissue
A

– 1 week—

1-3 months

61
Q

soft tissue swelling and discoloration
in the area of the mastoid, secondary to
blood in the mastoid air cells

A

Battle sign—

62
Q

_____represents periorbital ecchymoses,

may be seen with basilar skull fractures

A

Raccoon eyes—

63
Q

a bruise of the brain resulting in
infarct

Typically wedge-shaped and preferentially
affect the crown of the gyri

A

contusion

64
Q

contusions at a distance from and frequently roughly opposite to the point of trauma

A

Contrecoup lesions

65
Q

the object enters but
does not completely transverse the brain (stab
wounds, low velocity gunshot)

A

Penetrating brain wounds—

66
Q

________wounds in which the

object passes through the brain and exits

A

Perforating brain wounds—

67
Q

May get avulsion of the pontomedullary or cervicomedullary

junction with s_______

A

severe hyperextension

of neck

68
Q

-total failure of closure

– Brain and cord exposed to amniotic fluid

A

Craniorachischisis totalis—

69
Q

subcutaneous herniation of

meninges through defective closure of vertebral arch

A

Meningocele

70
Q

– Congenital dilatation of central canal
– Associated with meningomyelocele and Chiari
malformation
– Rarely symptomatic

A

Hydromyelia

71
Q

– Slit or tubular cavitation of cord (syrinx = tube)
– Most commonly cervical or thoracic cord
– Cavity may be multiple, irregular
– May be filled with fluid associated with
compression and damage to surrounding tissue

A

Syringomyelia

72
Q

failure of
anterior telencephalon to divide or normal forebrain
development, i.e., incomplete separation
of the cerebral hemispheres across the midline

A

Holoprosen

73
Q

• Downward herniation of cerebellar tonsils
• No elongation of medulla and 4th ventricle
• No associated spina bifida
• Often asymptomatic, may cause late-onset
hydrocephalus

A

Arnold chiari type 1

74
Q

Cerebellar malformations, displacement of

vermis below the foramen magnum

A

Arnold chiari type 2

75
Q

Hypoplasia or aplasia of cerebellar vermis
Cystic dilatation of 4th ventricle
• Enlargement of posterior fossa
• Hydrocephalus symptoms early, prominent
occiput

A

Dandy-Walker syndrome

76
Q

Most develop by the 16th week of gestation
All marked by an abnormal arrangement of
neurons in the cortex

A

(cortical

dysplasia)

77
Q

associations of cortical dysplasia

A

Association with tuberous sclerosis, neurofibromatosis

type I, and epidermal nevus syndrome

78
Q 
Normal development
–\_\_\_\_\_\_\_\_—first fissures form
\_\_\_\_\_\_\_\_\_—secondary sulci form
\_\_\_\_\_\_\_\_\_—tertiary sulci
form
A

5th month
– 3rd trimester
– 3rd trimester to 6 months of age

79
Q

• Pachygyria and polymicrogyria; poor cortical
layering
• Peroxisome abnormality

A

Zellweger syndrome

80
Q

Asymptomatic or associated with mental retardation,
seizures, and speech disturbances
– Associated with holoprosencephaly, pachygyria,
schizencephaly, fetal alcohol syndrome,
and X-linked dominant Aicardi’s syndrome

A

Agenesis of corpus callosum

81
Q

• Normal in newborn, separation of the leaflets
of the septum pellucidum
• Asymptomatic

A

Cavum septi pellucidi

PATHOLOGY (3 decks)

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